Provider Demographics
NPI:1336398726
Name:BURCH, ROBIN DOMM (NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:DOMM
Last Name:BURCH
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:BARBARA
Other - Last Name:DOMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:1790 MULKEY ROAD STE 10 BLDG 10
Mailing Address - Street 2:NEWBORN CLINICS OF AMERICA LLC AT WELLSTAR COBB CLINIC
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:404-606-0154
Mailing Address - Fax:678-615-2107
Practice Address - Street 1:1790 MULKEY RD STE 10
Practice Address - Street 2:NEWBORN CLINICS OF AMERICA LLC AT WELLSTAR COBB CLINIC
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1122
Practice Address - Country:US
Practice Address - Phone:404-606-0151
Practice Address - Fax:770-392-0180
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN065363 NP363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA624183405AMedicaid